For young people all over the world, the most prevalent causes of disability are in the mind. For youth, neuropsychiatric disorders including major depression and alcohol use comprise 45% of the disability burden among young people from 10 to 24 years old, according to a study published online Monday in the Lancet. That’s about four times as much as that caused by unintentional injuries (12%) and infectious and parasitic diseases (10%).

You have to do a little reading between the lines when it comes to arriving at any projected remedy to this rapidly escalating problem.

Young people’s health tends to be neglected when talking about global public health issues because they’re perceived as healthy, the authors point out. But catching problems earlier in life can improve longevity and quality of life over the long term.

Or not…

“Although risk factors and the lifestyles that young people adopt might not affect their health during this period, they can have a substantial effect in later life and can potentially affect the health of future generations,” the authors write. “For example, high patterns of physical activity that are adopted during youth and sustained thereafter are thought to have protective effects against the onset of cardiovascular diseases and Type 2 diabetes.”

Problem! The drugs most commonly used to treat so called “serious mental illness” can cause a metabolic syndrome that greatly increases the chance of developing a cariovascular disease and diabetes. A big danger here is that by blindly pursuing standard psychiatric practice the population of young mentally disabled people will increase rather than decline.

The article, Helping mentally ill go back to work a win for all, an opinion piece in The Australian about how the face of disability there is changing from elderly people suffering from musculoskeltal conditions to young people with psychiatric labels, concludes by pointing to more realistic solutions to this problem.

But as the number of people with psychological conditions on disability pensions increases, and the age profile of disability pensioners shifts, we will need to look at more fundamental ways to keep relatively young people with a disability off welfare and in the workforce.

I don’t know how it works in Australia, but in the USA disability benefits and welfare benefits are not synonymous. The idea is to get people off Social Security Disability Income benefits as well. Another snag in this outlook is that people are not supposed to receive SSDI unless they suffer from a permanent disability. We have perception and definitional confusions here that must be resolved before we can affect a reasonable solution to this shortcoming. A person who suffered from permanent disabilities would by definition be excluded from the workforce. This is a particularly trying problem as the social security bureaucracy expects people to prove disability in order to receive benefits. Getting off benefits is not a possibility allowed for by this bureaucracy. I suggest that we need to loosen our definitions in the interests of accurately accessing reality, and of reintegrating people back into the workforce, and back into the community at large.

For many people with mental illness, the disability pension as a one-way street with few requirements and little help to get back into the workforce is simply not good enough.

The exact same statement could be made about people with psychiatric labels and SSDI benefits in the USA. It is my fear that such financial dependence, as shown by the preceding article and study, is growing increasingly common on a global scale.

For a time this year, a psychiatric hospital run by the state of Maryland didn’t have enough injectable drugs for schizophrenia patients who refused to take pills.

What this article doesn’t tell you is that these drugs are dangerous. They can cause permanent brain damage, and they cause a metabolic syndrome that can cut short a life by many many years. I don’t think anybody should be forced to take such drugs who doesn’t want to do so. I don’t think people should be forced to imbibe alchohol or snort coke who don’t want to do so either.

I’d like to point out that this alarmist first sentence shows an astonishing lack of regard for the humanity of people imprisoned inside state mental hospitals. It is considered entirely acceptable to disregard their citizenship rights. It is considered entirely acceptable to physically assault them, and to drug them into a numb oblivion. Neither one of these precedures are acceptable in my book, and they never will be. Since when did the branch of what purports to be a medical science become grafted onto the trunk of the tree of police science!?

This sort of callousness points to the fact that prisoners in state mental hospitals DON’T have the right to choose what kind of treatment they receive. It points to the fact that they are 1. prisoners, and 2. forcibly treated. Imprisonment and coerced drugging are violations of one’s human and civil rights to freedom of movement, and to security of mind, body and person.

That such a sentence would serve as an introduction in an article of this sort indicates, to use a metaphor, just how steep a climb psychiatric survivor and mental health consumers have yet to summount before their citizenship rights are officially acknowledged, publicly recognized and fully restored.

People in mental health treatment are also at risk for developing tardive dyskinesia due to the neuroleptic drugs some of them are prescribed for psychosis and bipolar mania. Lawyers know better than to try to mount such a defense for them. When they are not accorded the rights of full and complete citizens, of course, they don’t stand much of a chance of winning such a case in court.

Reporting from Washington— The Supreme Court gave the pharmaceutical industry a pair of victories, shielding the makers of generic drugs from most lawsuits by injured patients and declaring that drug makers have a free-speech right to buy private prescription records to boost their sales pitches to doctors.

What kind of “free-speech” is a bought “private prescription record”!? (Emphasis added.)

The government just entered the drug selling trade and, frankly, I don’t think that is a place where the government belongs.

The patients, Gladys Mensing and Julie Demahy, developed tardive dyskinesia, a severe neurological disorder, after taking metoclopramide, a generic form of the drug Reglan for digestive problems, including acid reflux. They sued, alleging that the drug maker failed to warn them of the danger of taking this drug for more than 12 weeks. Studies had suggested a potentially increased risk of the condition — and Reglan was eventually required to carry a “black box” warning about it. That wasn’t the case at the time.

Just imagine getting a permanent neurological movement disorder, a physical disability, from the drug you used to treat your gas, and then not being able to sue the company responsible for making it.

This decision means brand name drug makers can be sued, and generic drug makers can’t be sued. Go figure…

In the second decision, the court by a 6-3 vote struck down a Vermont law that barred pharmacies, drug makers and others from buying or selling prescription records from patients for marketing purposes. Vermont’s physicians had sought passage of the law, arguing that their prescriptions were intended for private use of patients and should not become a marketing tool.

Some people could be so desperate as to sell prescription records. You just have to wonder about Supreme Court Justices who are so desperate as to sell their rulings to the highest corporate bidder. I’m still looking for the freedom involved in such puppetry. I’m wondering who our politicians might have sold it to.

I can’t help thinking that maybe poor parenting skills are behind the current epidemic of childhood “mental disorder” labeling. Newsweek just did a story on the trend of labeling children with bipolar disorder in an article titled Mommy, Am I Really Bipolar?

In the autumn of 1994, a novel idea was afoot in my profession. At the annual conference of the American Academy of Child and Adolescent Psychiatry, I attended a workshop on bipolar disorder in children. About 10 of us attended the meeting, held in a small, poorly lit room. Only one or two doctors reported having actually seen a child with bipolar disorder, but we all agreed to keep our eyes open for other sightings.

Bipolar disorder in a child would have been a much rarer sighting for the experts to make in 1994.

Dubious math is then used to offset the 40 fold, that’s 4,000 %, increase in childhood bipolar disorder that occurred in the USA soon after. Sure, childhood bipolar disorder may have increased in some other places, too, but in no other place would it take off like it has in the USA. The birthplace of kiddy bipolar mania was the good ole’ USA, and that is, of course, where as a diagnosis it has met with the most success.

In adults, bipolar disorder is characterized by cycles in which a patient rotates between two extremes, or poles, of feeling: depression and mania. The cycles may vary in length and intensity, but the adult diagnosis depends on clear-cut episodes of behavior that is distinctively different from normal: severe overexcitement or highs that last for weeks, and crushing, painful periods of deep depression that also last for weeks or months. The description of childhood bipolar disorder by its advocates is dramatically different. Where adult bipolar disorder expresses itself in episodic, out-of-character behavior, a child diagnosed with bipolar disorder will have symptoms that characterize the child’s typical behavior. In this telling, an elementary-school-age child with the disorder may be chronically enraged and have several tantrums per day. But this only points to another problem with the diagnosis: it’s nearly impossible to distinguish between children alleged to have bipolar disorder and those with straightforward anger-control issues. The symptoms may look like mania: irritability, distractibility, and talkativeness. But most of these symptoms can easily be matched to less-trendy conditions like attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). My view is that a diagnosis of bipolar disorder in a child is almost always a case of severe ADHD combined with severe ODD, both fairly common in elementary-school children.

In the “disorder” business, it’s taboo to be caught without a “disorder” on your fingertips, and at your disposal. If it’s not Bipolar Affective Disorder; it must be that other trendy figment of folks collective imagination, Attention Deficit Hyperactivity Disorder. The Attention Deficit Hyperactivity Disorder craze, after all, started long before the Bipolar Affective Disorder craze. This is the primrose path that this bozo leads us down compounding his folly with the addition of another even more dubious disorder, Oppositional Defiant Disorder. ODD is the disobedient children’s disorder that parents have been dreaming about all their lives. ‘You listen to me, kid, or you’re sick!’

I realized this when I met Alexis, a brilliant 11-year-old girl from a prominent family. She was a talented artist who spent her sessions with me crafting elaborate Renaissance-like drawings and discussing her rehearsals in an adult Shakespearean troupe. Alexis, however, had always performed poorly at school, refusing to participate in the classroom and opting instead to chat with the adults in the teachers’ lounge. Her constant urge to move, her refusal to do her homework—these suggested evidence of ADHD. Yet her parents, having been told that she had a far more serious (and lofty) disorder, resisted the diagnosis. When they reluctantly allowed me to stop her mood stabilizers and instead prescribe stimulant medication for ADHD, this talented child quickly became a well-functioning girl who participated eagerly and happily in class with her peers. Her parents canceled their plans to dispatch her to a boarding school for the emotionally disabled.

The key to ADHD, and this whole paragraph, comes with the 2nd sentence in it. “Alexis…always performed poorly at school…” ADHD, in theory anyway, is the magical formula for getting students who perform poorly a top grade education. The theory runs that if we just give them speed then they can keep up with their peers. I happen to believe perhaps counseling, tutoring, and a remedial study skills course might take you farther. Of course, such extras come at a price, and it’s cheaper just to drug the child. Oh, and I don’t mean financially either. I mean in terms of effort, authentic concern and expenditure of energy, it’s just so much easier.

Psychiatrist Stuart Kaplan, the author of this rather disappointing piece, at the end points towards Temper Dysregulation with Dysporia (TDD) projected in the upcoming DSM as a corrective to the Childhood Bipolar Disorder fiasco. The TDD disorder label is seen as corrective as if this projection wasn’t likely to lead to yet another trendy disease label for shrinks and drug company exes to bank on. If ADHD had been popular, if kiddy BAD has become popular, just make way for TDD. The reasoning and the charm of it is, it won’t be seen as the “serious” disorder label that Bipolar Disorder is seen as being. If it’s the beginning of a downward spiral, well, it has lot’s of company.

Every time I read a statement from the current director of the National Institute of Mental Health, Thomas Insel, I have to meditate on how good it would be if the NIMH were to hire a new director. His speech at the 2011 APA convention bash in Honolulu was apparently no exception. Psychiatric News has an article on the affair, Brain, Gene Discoveries Drive New Concept of Mental Illness.

Insel said psychiatric research today promises to produce a true science of the brain based on three core principles (see Points to Remember):

1. Mental disorders are not brain disorders. Brain disorders are brain disorders.
2. Mental disorders are not developmental disorders. Developmental disorders are developmental disorders.
3. Speculations about the source of mental disorders are just that, speculations.

He draws some pretty peculiar conclusions from research in DNA.

One of the most surprising findings from the Human Genome Project has been that psychiatric disorders, unlike common medical illnesses, appear to be the result of extremely rare, but highly penetrant—or potent—genetic variations. And these variations are not associated with any specific illness, but with a variety of phenotypes recognized as mental disorders, Insel said.

Dr. Insel wants us to think a mental disorder is a brain disorder. This isn’t just semantic confusion, its definitional confusion. This is New Psych Speak talking. This is Big Brother Big Sister therapeutic nanny state propaganda. Brain is no more mind than ‘war is peace’. Perhaps a more apt analogy would be to confuse a radio with the music it plays. They are not synonymous.

After making mental disorders out to be common medical illnesses, he would base these common medical illnesses on rare genetic variations. If these common medical illnesses were based on rare genetic variations they wouldn’t be common medical illnesses. I think we’ve got a long ways to go before we can say a common mental disorder is caused by a rare genetic variation. On the other hand, I think we can safely say that every individual on earth is the result of his or her own rare genetic variation.

“Rethinking mental illness means changing the emphasis so that you make sure the worst outcomes don’t happen,” he said. “We need to ask the question, How does variation in the genome lead to changes in particular neuronal circuits, which in turn bias the way an individual deals with emotional regulation?”

Dr. Insel is confusing the thought process with the organ of thought again. If genetics explains everything then “the worst outcome” has already occurred. Research, at pains to find an organic explanation, is pursuing the genetic angle. In the process of trying to lay it all on the genome, this same research is having to bow to environmental factors more and more. Perhaps eventually the genetic factor is going to count for less and less, that is to say, perhaps the problem wasn’t so organic to begin with.

Some arguments are such that I feel compelled to answer them. Such was my feeling after reading social work lecturer Ken McLaughlin’s lecture, The unhelpful myth that we’re all a bit mad. I imagine him to be more comfortable with the myth that most of us are quite sane. Given the state of the planet earth after much human interaction on it, I find that myth highly questionable myself.

One argument put forward by several participants was that to understand mental health/distress it was necessary to view it as a continuum, with mental health at one end of the continuum and mental distress at the other. We are all placed somewhere on the continuum and we will all, at some point, move along it, for better or worse, in one direction or another. In other words, there is no rigid divide between mental health and mental illness; therefore, to classify some people as mentally ill sets up an ‘us and them’ situation, with ‘them’ being stigmatised and oppressed. The continuum model is one that is advocated by many in the mental-health field today, and one which seems to make sense. Yet in truth, it is a flawed and unhelpful model which does little to help those in need but much to categorise us all as mentally vulnerable.

I’m not sure counterpoising mental health to distress is a particularly fruitful parellell to make. I do think it might be better to compare more distress with less distress. More distress tends to find itself pathologized while less distress doesn’t tend to find itself pathologized quite so often.

I don’t, by the way, think the view “that we’re all a bit mad” is really an “unhelpful myth”. In fact, I don’t think it a myth at all. A big misunderstanding occurs where people forget that people experiencing distress are human beings, too, just like they are. Alienation, after all, is a big factor in the distress that many people experience. Alienation has a human face even if that face sometimes resembles a mask.

Another weakness in the continuum proponents’ case is that, in reality, they themselves do not believe it. Many of them frequently make decisions as to who is ‘different’ to the vast majority of the population. For example, even the most radical and progressive mental-health resource programmes, such as therapeutic communities and user/survivor asylum and support interventions, make assessments as to who should and who should not access their services. In other words, they operate eligibility criteria, making a distinction between people on the basis of their mental state. They may reject the medical model of classification and treatment, but they themselves classify and differentiate. Whatever model of mind is used to make the distinction, the end result is the same: the continuum is broken.

I don’t know that anybody is arguing that there is not a point on a continuum where a person would receive a psychiatric label, or when the person’s condition might be seen as pathological. I don’t see any broken continuum. I don’t see a broken continuum because I believe recovery from life crises is possible. This recovery would put a person on a continuum that would allow proceeding from a state of more distress to a less distressed state. Where this continuum is broken, as far as I’m concerned, what you would be dealing with is sub-human, or people for whom the same rules don’t apply as are generally applied to the species homo-sapiens.

Mr. McLaughlin sees a continuum of weakness or vulnerability being applied here but, frankly, I don’t see why we couldn’t just as easily envision a continuum of strength and determination applied, within limits, of course. At one end of the continuum is strength, and at the other end is weakness. Good mental health I assume would probably be more pervasive at the strong end of the continuum rather than at the “wrong”ed end of the continuum.

In an attempt to avoid such reactions to this piece I shall misquote the singer Carly Simon: ‘You’re so vain, you probably think this article’s about you.’ It’s not – but there is a pressing need to stop blurring the lines between everyday troubles and genuine mental distress.

Alright, is this article about “everyday troubles” or is this article about “genuine mental distress”? In either case I think it touches everybody. My feeling is that Mr. McLaughlin is a convert to the biological medical model religion of psychiatry, and that his conversion explains the linguistic camouflage he uses to disguise that bias. The church of psychiatry firmly believes in the brokenness of the continuum Mr. McLaughlin uses to illustrate his argument. I, in the interests of recovery and humanity, happen to favor the tunnel of an unobstructed continuum over any such abrupt and fatal cave-ins. The problem I see with his theory is that a broken continuum is a continuum nonetheless. It is just a continuum in need of repairs, or “healing” as some people put it.

The Sacramento Bee has started a disturbing opinion piece series, coupled with a forum, in The Conversation: A Journey Into Darkness. The editorializing of this article focuses on one specific case of a young man labeled with “mental illness”, and his families alarm over the situation this young man has created for himself. From this specific case the opinion piece then proceeds to generalize about all cases without reference to any other specific cases.

I personally favor deductive reasoning over such inductive methods. As we haven’t made this case the rule simply by treating it as such, it is always possible that it could be exceptional.

The father of this young man has taken to lobbying the state for more draconian mental health laws. He is trying to get a law enacted to force psychiatric drugs on people who have no desire to take such drugs.

I didn’t like him as a Governor (I was in California for a small amount of time back then), and I liked him even less as a President, but Ronald Reagan may be deserving of a little praise for some of the things he did while he was around.

In the 1960s, California had 14 state hospitals that housed 36,000 patients. Gov. Ronald Reagan pushed to empty the facilities, and found allies among conservatives who saw a chance to save money, and liberals who saw abuses and sought to grant patients greater rights. They emptied the hospitals, but never sent money to counties to fund community care.

Okay, and excluding the possibility that perhaps Ronald Reagan has been given much undue credit…

The state hospital population fell to 3,410 patients by 1995. The pendulum is swinging. The population under the care of the California Department of Mental Health is expected to reach 6,324 next year.

Subtract 3,410 patients from 36,000 patients, and you get 32,599 patients who were no longer held in the state hospitals. This isn’t magic. They didn’t need to be there in the first place. Subtract 6,324 patients from 36,000 patients, and you get 29,676 patients. Either way, this represents a vast improvement over the 1960s.

We’ve now come to the scary part of the equation.

However, the mix is very different. Twenty years ago, half the people in the few remaining state hospitals had committed no crime. Now, 92 percent of the patients are in for Penal Code violations. Many thousands more severely mentally ill people are housed in state prisons.

When 92 % of the patients in California psychiatric institutions are now forensic patients, the authorities must be using criminal law, petty or otherwise, with more frequency than ever before to detain people in the mental health system.

Many ex-patient advocates will tell you that they were once labeled “severely mentally ill” themselves. The line between the person with a “major mental illness” label and the person with a “minor mental illness” label is not as broad as some people may imagine it to be. People recover from “serious mental illness” labels, they join the ranks of the mentally well, and they get on with their lives. More funding for community mental health programs might help, provided those programs were effective. Such is not always the case. This matter is actually about intolerance and criminalization, and those are the issues that should be addressed in any discussion of this sort.